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ACUTE MANAGEMENT OF TRAUMATIC SPORTS INJURIES. HENRY T. GOITZ, MD Academic Chief – Sports Medicine Institute Director – Education, Research, Injury Prevention Center Co-Director – Orthopaedic Sports Medicine Fellowship DETROIT MEDICAL CENTER DETROIT, MICHIGAN.

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acute management of traumatic sports injuries

ACUTE MANAGEMENT OF TRAUMATIC SPORTS INJURIES

HENRY T. GOITZ, MD

Academic Chief – Sports Medicine Institute

Director – Education, Research, Injury Prevention Center

Co-Director – Orthopaedic Sports Medicine Fellowship

DETROIT MEDICAL CENTER

DETROIT, MICHIGAN

extremity don t miss lesions
EXTREMITY “DON’T MISS” LESIONS*

TENDON

(Rupture/ Tears)

LIGAMENT

(Joint Dislocations)

BONE

*MISSED EXTREMITY INJURIES THAT WILL GET YOU SUED…..

tendon rupture
TENDON RUPTURE

Quadriceps/ Patella

Acute Rotator Cuff

Distal Biceps

Achilles

quadriceps patellar tendon rupture
QUADRICEPS/PATELLAR TENDON RUPTURE

HISTORY: Forceful Thigh Contraction/Push Off

EXAM: Palpable Defect/ Extension Lag

X-RAY: Patella Alta/Baja

Management: Brace, Surgery (2 weeks)

acute rotator cuff rupture
ACUTE ROTATOR CUFF RUPTURE

History: Fall, Age >40

Exam: “Drop Arm” Sign (Can’t Abduct Arm), Weak External Rotation (Massive)

X-ray: Negative

MRI, U/S: Positive

Management: Sling, Surgery (2 weeks)

distal biceps tendon rupture
DISTAL BICEPS TENDON RUPTURE

HISTORY: Lift Object, Painful Pop

EXAM: Ecchymosis, +/- Popeye Muscle

X-RAY: Negative

MRI, U/S: Positive

Management: Sling, Surgery (2 weeks)

achilles tendon rupture
ACHILLES TENDON RUPTURE

HISTORY: Push Off, Tear, Kicked

EXAM: Palpable Defect, Thompson Sign NO Plantar Flexion*

X-RAY: Negative

Management: Splint, Surgery (2 weeks)

don t miss joint dislocations associated conditions
“DON’T MISS” JOINT DISLOCATIONS’ASSOCIATED CONDITIONS

Deformity Obvious

+/- Fracture

Neuro Vascular Involvement

anterior shoulder dislocation
ANTERIOR SHOULDER DISLOCATION

HISTORY: Fall, Arm Abducted, Externally Rotated, Painful

EXAM: “Squared Off” Shoulder

X-RAY: AP/ Axillary KEY

TREATMENT: ED Reduction

posterior shoulder dislocation
POSTERIOR SHOULDER DISLOCATION

HISTORY: Seizure, Electrical Burns

EXAM: Can’t Externally Rotate

X-RAY: AP, AxillaryKEY

TREATMENT: ED Reduction

knee dislocation
KNEE DISLOCATION

History: High Velocity/ Load

Exam: Gross Deformity; Popliteal Artery Injury

Peroneal Nerve Injury

X-ray: Gross Deformity, MRI: 3 of 4 Ligament Tear

Management: Reduce, Evaluate Vascular Status, Evaluate Neuro, Splint

elbow dislocation
ELBOW DISLOCATION

History: Fall

Exam: Gross Deformity

X-ray: Gross Deformity, RadioCapitellar Line

Management: Reduce, Check Stability via ROM, Splint vs. Sling vs. Brace

hip dislocation
HIP DISLOCATION

History: MVA Knee-Dash

(Subluxation* in Sport)

Exam: Limb Shortened, Externally Rotated

X-ray: Dislocation*

Management: Reduce, Crutch

* AVN risk

ac acromioclavicular separation
AC (AcromioClavicular) Separation

History: Fall

Exam: Range—Pain to Prominence

Xray: Range—Normal to Prominance

Management: Sling

patella dislocation
PATELLA DISLOCATION

History: Twist Knee

Exam: Lateral, Painful Prominance

X-ray: Dislocation

Management: Extend Knee, Reduce Patella

patterns of referred pain
PATTERNS OF REFERRED PAIN

SHOULDER—NECK

1. Pain: Deltoid vs. Radicular

KNEE—HIP

1. Pain: Focal Knee vs. Groin